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GFAOP An example of a cancer specific network
that builds capacity and drives policy commitments
Mhamed Harif Hôpital Cheikh Khalifa, Casablanca, Morocco
French Speaking Africa
North Africa PO activity
Sub-
Saha
rian
Afric
a N
o PO
act
ivity
French-African Paediatric Oncology Group GFAOP 2000 (Jean Lemerle)
French Speaking Africa
French-African Paediatric Oncology Group
Bénin Burkina Faso Burundi Cameroun Comores Côte d'Ivoire Djibouti Gabon Guinée Guinée équatoriale Madagascar Mali Niger République centrafricaine République démocratique du Congo République du Congo Rwanda Sénégal Seychelles Tchad Togo 21 countries, 301 millions inhabitants
Official language
Algérie Maroc Maurice Mauritanie Tunisie 5 countries, 91 millions inhabitants.
Widely used
Pilot Unit
Support to patients and
families
Clinical research
Development of competences
French-African Paediatric Oncology Group GFAOP 2000
8 PO pilot units 6 African countries
Algeria : Algiers Oran Cameroon : Yaoundé Madagascar : Antananarivo Morocco : Rabat Casablanca Senegal : Dakar Tunisia : Tunis
French-African Paediatric Oncology Group GFAOP 2000
French-African Paediatric Oncology Group GFAOP
------- Created in April 2000 -------
Objective • Improve the management of childhood cancer in Africa • Setting up a database of paediatric cancer in Africa
Methods
• Teaching and training • Improving access to care • Improving awareness regarding paediatric cancer • Developing adapted clinical research programs • Develop local support
----Therapeutic research----
Feasibility phase Objective : Protocol feasibility in “African medical
condition” 2 protocols : Wilms tumor and Burkitt lymphoma
• North Africa Countries : almost unchanged SFCE or SIOP protocol
• Sub-Saharan Countries : ‘adapted’, less toxic
Development phase • Improve the first results • Develop new protocols
Cyclophosphamide in Burkitt lymphoma Acute lymphoblastic leukemia Hodgkin disease Retinoblastoma
French-African Paediatric Oncology Group
306 200 141 109 83 44 22
0,00
0,10
0,20
0,30
0,40
0,50
0,60
0,70
0,80
0,90
1,00
0 6 12 18 24 30 36
Mois
LMB GFAOPOverall Survival
protocoles GFA et MAT
A risque
OS according treatment regimen French-African Paediatric Oncology Group
OS according to year of admission
French-African Paediatric Oncology Group
Burkitt Lymphoma Subsequent studies : 2005 – 2015
North Africa : MAT II protocol
Sub-Sahara units Cyclo-Burkitt GFAOP protocol
85 60 52 50 50 48 48 48 48 70 50 45 39 37 36 28 21 12
0.00 0.20 0.40 0.60 0.80 1.00
0 6 12 18 24 30 36 42 48 Mois
MAT2- stade III OS Rabat selon période
période 03/2005-12/2008 n= 85 période 1/2009- 03/2014 n= 70
A risque
logrank p = 0.008
81%
61%
French-African Paediatric Oncology Group Traitement LNH Afrique du nord
OS with second line treatment
2224729
24729563
0,00
0,20
0,40
0,60
0,80
1,00
0 6 12 18 24 Mois post dg
stade Istade IIstade IIIstade IV
64%
21%
A risque
B-cell lymphoma French African Pediatric Oncology Group
Sub-Saharan Africa: Cyclo-Burkitt
OS Burkitt st 1cyclo Burkitt
juin 2013
111114161718212130
0,00
0,20
0,40
0,60
0,80
1,00
0 3 6 9 12 15 18 21 24Mois
n=30
A risque
84%
B-cell lymphoma French African Pediatric Oncology Group
Sub-Saharan Africa: Second study
Lessons
B-cell lymphoma studies
1. Overall good results with improvement over time 2. High rate of death at initiation (TLS) 3. Cyclophosphamide alone is a good treatment of stages
I/II but needs rapid rescue
B-cell lymphoma French African Pediatric Oncology Group Study
Nephroblastoma
First study : 2001 – 2004
French African Pediatric Oncology Group
Wilms tumor program French African Pediatric Oncology Group Study
Adapted SIOP protocol
Wilms tumor program French African Pediatric Oncology Group Study
139 123 111 96
91% at 3 y
56 25 161 96 61 39
73% at 3 y
17 3
00% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
0 12 24 36 48 60
Post-surgical months
Study II: OS
OS Maghreb OS Sub Saharienes
A
Adapted SIOP protocol
NEPHROBLASTOMA French African Pediatric Oncology Group Study
Lessons
Wilms tumors studies 1. Overall good results with improvement over time 2. High rate of exclusion 3. Pathology staging problem 4. Needs for radiotherapy in sub-saharian Africa
Other programs
Hodgkin Acute lymphoblastic leukemia Retinoblastoma
French-African Paediatric Oncology Group GFAOP
HD-GFAOP protocol strategy
Hodgkin’s disease French African Pediatric Oncology Group
127 cases
Bamako Dakar Yaoundé Abidjan Tananarive Ouagadougou Lubumbashi
89 65 54 43 35 23 17 89 65 52 39 33 21 15
0.00 0.20 0.40 0.60 0.80 1.00
0 6 12 18 24 30 36 Months
HD-GFAOP 2006- 2012 study
OS n= 89 EFS n= 89
A
82%
67%
Hodgkin’s disease French African Pediatric Oncology Group
GFAOP-ALL Standard risk- protocol
Induction 5 weeks
Consolidation 12 weeks
Intensification 8 weeks
Maintenance 18 months
PRD / DXM ; VCR ; L Aspa + 2 IT
PRD ; VCR MTX ; 6 MP + 3 IT
DXM ; VCR ; Adria ; 6 MP ; Ara C + 2 IT
6 MP ; MTX 9 IT
Burkina Faso Cameroun Madagascar Mali Sénégal République du Congo
147 patient included
Acute lymphoblastic leukemia French African Pediatric Oncology Group Study
GFAOP-ALL Overall survival Survie sans décès A 12 mois 74% IC=[65% ; 83%] A 18 mois 62% IC= [50%; 73%]
Médiane de suivi: 11,9 mois
24
Acute lymphoblastic leukemia French African Pediatric Oncology Group Study
Retinoblastoma program launched in Bamako on November 2011
Retinoblastoma program French African Pediatric Oncology Group Study
Sub-Saharan Africa
45 30 18 10 13 4 2 1
0.00 0.20 0.40 0.60 0.80 1.00
0 6 12 18 months after diagnosis
Preliminary results Retinoblastoma
EFS
intra ocular n=45 extra ocular n=13
At risk
logrank :p = 0.34
Retinoblastoma program French African Pediatric Oncology Group Study
Sub-Saharan Africa
Conclusion
Multicentric and prospective studies are feasible in Africa
Survival is improving Needs of improvement of supportive care
and multidisciplinary approach
French-African Paediatric Oncology Group GFAOP
North Africa Tunisia 1 unit Algeria 2 units Mauritania 1 unit Morocco 4 units
West Africa
Senegal 1 unit Ivory Coast 1 unit Mali 1 unit Burkina Faso 1 unit Togo 1 unit
Central Africa Cameroon 1 unit Rep Dem Congo 1 unit
Madagascar Antananarivo 1 unit
French-African Paediatric Oncology Group Paediatric Oncology Units involved
2016
16 units/12 countries
GFAOP Regimen Others TOTAL 2009 356 173 529 2010 425 186 611 2011 512 236 748 2012 532 310 842 2013 656 417 1073 2014 696 460 1156
Number of cases treated in sub-Saharan area in PU
French African Pediatric Oncology Group
French African Pediatric Oncology Group
Lalla Salma Fondation
First house of parents of children with cancer in sub-Saharan Africa (Abidjan, Cote d’Ivoire)
GFAOP Challenges and Ideas for future development
French African Pediatric Oncology Group
Challenges
Improving care in POU • Tackling abandonment:
Information, support for the families, improvement of access to care
• Improving supportive care • Data management
Expanding activity to other cancers
Expanding activity to other regions and
countries
Ongoing actions Competence challenge
Who? Pediatricians, oncologists, hematologists, pathologists, surgeons,
pediatricians and residents How? Intensive courses Diploma on PO Training…
African School of Pediatric Oncology (MCM, Lalla Salma Foundation, Institut Gustave Roussy, Université Paris Sud,
Université Mohammed V Rabat)
French African Pediatric Oncology Group
African School of Pediatric Oncology
Ongoing actions Improving education in POU
First nursing course on PO Marrakech April 2011: Participants: 40
Country Maroc : 29 Algérie: 02 Tunisie: 02 Sénégal: 01 Mali: 01 Cameroun: 02 Togo: 01 Cote d’Ivoire: 01 Burkina Faso:01
Previous course on PO 12/40
Cours intensif de Chirurgie Oncologique Pédiatrique
21-23 Octobre 2013
French African Pediatric Oncology Group
Intensive course for nurses
French African Pediatric Oncology Group
African School of Pediatric Oncology
Diploma on pediatric oncology (MCM, Gustave Roussy, Université Paris Sud, Université Mohammed V Rabat)
20 to 25 well trained MD in PO in French speaking area each year
Competence challenge
Groupe Franco-Africain d’Oncologie Pédiatrique
GFAOP Secrets!
Long term involvement
Empowerment of African teams
Early implementation
of clinical evaluation and
research
Total approach
GFAOP family
Aknowledgement
